Remnant Stomach and Gastric Cancer

Abstract

Before the modern era of H2-receptor antagonists and proton pump inhibitors, gastric surgery was the sole effective treatment for ulcer disease. Successful partial gastrectomy with gastroduodenostomy was first performed by Theodor Billroth in 1881 for distal gastric carcinoma; 1 year later Ludwik Rydygier performed a similar operation for ulcer disease with gastric outlet obstruction. Over the next few decades the Billroth I- operation was extensively attempted and modified. In 1885 Billroth introduced another anastomotic principle, using closure of the duodenum and a gastrojejunostomy (Billroth II). Parallel with the introduction of partial gastrectomy, Wolfler designed a gastrojejunostomy which was favored by most surgeons, being an easier, more rapid, and thus safer method. However, due to the high frequency of postoperative complications this method was abandoned in the 1920s and partial gastrectomy according to Billroth I or Billroth II became the method of choice. The latter operation took over as the standard procedure in peptic ulcer disease, reaching its peak of popularity in the mid 1950s. Later Billroth I regained popularity but was soon taken over by proximal gastric vagotomy.